Klonopin - Long Term

[TheSeanieB]

In studing the mechanism of Klonopin, I don't see how patients can take it long-term for things like anxiety. However, I have notice in the clinical setting that it is quite commonly prescribed for years at a time. Am I missing something or are there patients that are paying a big price down the road?

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[jdh71]

In studing the mechanism of Klonopin, I don't see how patients can take it long-term for things like anxiety. However, I have notice in the clinical setting that it is quite commonly prescribed for years at a time. Am I missing something or are there patients that are paying a big price down the road?

A patient on klonopin is like having a tiger by the ears - not so easy to let go. I never use it and never will. If my psychiatric specialists put a patient on it I'm ok with that expert opinion.

You should perhaps ask your question in the psych forum.

 

[Bostonredsox]

Benzos in general are very difficult beasts to manage longterm. Klonopin has slightly less abuse potential than alprazolam and is dosed a little less frequently so it has remained popular amongst the psychiatrists for longterm anxiety. Alot of PCPs are trying paxil and other non benzos for these patients to try and prevent the dependency and overdose complications but alot of them end up on tid xanax or bid ativan in the end. Then again I am just going to give them some prn ativan IV if I need them to calm down and when they leave the unit someone else can deal with their everyday PO benzo use. Not a battle I want to partake in. I agree with JDH, I do not use it.

 

[393656]

Not sure what you revealed when studying the mechanism but there is no reason why it is not effective long-term. You would be surprised how many people do very well on the same dose for years at a time. Klonopin is nice because you can dose once a day with great coverage, it is sedating enough to assist with sleep (most anxious patients have insomnia) and has the lowest abuse potential because of its half life and its modest lipid solubility compared to most others-does not hit the brain very fast at all so no high.

While some forsure build tolerance but it is often people who overtake it or take it for the wrong reason. The most common use for myself is for the first few months in anxiety disorders while I am titrating up the SSRI as people with anxiety have a tough time tolerating SSRI's at the doses they need. Also a great augmentation for bipolar folks to keep them from ever having insomnia.

Its my favorite benzo by far.

 

[TheSeanieB]

Not sure what you revealed when studying the mechanism but there is no reason why it is not effective long-term. You would be surprised how many people do very well on the same dose for years at a time. Klonopin is nice because you can dose once a day with great coverage, it is sedating enough to assist with sleep (most anxious patients have insomnia) and has the lowest abuse potential because of its half life and its modest lipid solubility compared to most others-does not hit the brain very fast at all so no high.

While some forsure build tolerance but it is often people who overtake it or take it for the wrong reason. The most common use for myself is for the first few months in anxiety disorders while I am titrating up the SSRI as people with anxiety have a tough time tolerating SSRI's at the doses they need. Also a great augmentation for bipolar folks to keep them from ever having insomnia.

Its my favorite benzo by far.

Your take seems consistent with what I observed shadowing and make a lot of sense as you explain it. What happens really long-term to these patients, 10-20 years down the road. Wouldn't the anxious or bipolar eventually lose the benefit of the medication.